Unmet long‐term care needs and depression: The double disadvantage of community‐dwelling older people in rural China

Abstract Background Orthostatic hypotension (OH) is associated with increased risk of falls, cognitive impairment and death, as well as a reduced quality of life. Although it is presumed to be common in older people, estimates of its prevalence vary widely. This study aims to address this by pooling the results of epidemiological studies. Methods MEDLINE, EMBASE, PubMed, Web of Science, and ProQuest were searched. Studies were included if participants were more than 60 years, were set within the community or within long-term care and diagnosis was based on a postural drop in systolic blood pressure (BP) ≥20 mmHg or diastolic BP ≥10 mmHg. Data were extracted independently by two reviewers. Random and quality effects models were used for pooled analysis. Results Of 23,090 identified records, 20 studies were included for community-dwelling older people (n = 24,967) and six were included for older people in long-term settings (n = 2,694). There was substantial variation in methods used to identify OH with differing supine rest duration, frequency and timing of standing BP, measurement device, use of standing and tilt-tables and interpretation of the diagnostic drop in BP. The pooled prevalence of OH in community-dwelling older people was 22.2% (95% CI = 17, 28) and 23.9% (95% CI = 18.2, 30.1) in long-term settings. There was significant heterogeneity in both pooled results (I2 > 90%). Conclusions OH is very common, affecting one in five community-dwelling older people and almost one in four older people in long-term care. There is great variability in methods used to identify OH.

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Determinants of long-term care insurance applications in South Korea

Journal of Public Health ◽

10.1093/pubmed/fdaa094 ◽

2020 ◽

Author(s):

Sunhee Park ◽

Heejung Kim ◽

Chang Gi Park

Keyword(s):

Older Adults ◽

South Korea ◽

Long Term Care ◽

Community Dwelling ◽

Care Needs ◽

Term Care ◽

Factors Affecting ◽

Long Term Care Insurance ◽

The Government

Abstract Background South Korea established universal long-term care insurance (LTCI) in 2008. However, actual requests for LTCI remain lower than government estimates because some eligible candidates never apply despite their strong care needs. This study aimed to examine factors affecting LTCI applications for older, community-dwelling Koreans. Methods Both individual- and community-level data were obtained from a national dataset from the Korea Health Panel Survey and the Korea National Statistical Office (N = 523). Data were analyzed using multilevel modeling. Results Only 16.4% of older adults in need of care applied for LTCI. Those who applied were more likely to be older, report poor self-rated health, receive care from non-family caregivers, and have caregivers experiencing high levels of caregiving burden. Regional differences in LTCI applications existed concerning the financial condition of one’s community. Conclusions Our study findings emphasize that Korean LTCI should implement both individual and community strategies to better assist older adults in properly acquiring LTCI. The government should make comprehensive efforts to increase access to LTCI in terms of availability, quality, cost, and information by collaborating with local centers.

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Factors affecting community-dwelling older people's long-term care needs and utilization : a case study in Beijing, China

10.5353/th_991043976390003414 ◽

2017 ◽

Author(s):

Yuanyuan Fu

Keyword(s):

Long Term Care ◽

Community Dwelling ◽

Care Needs ◽

Term Care ◽

Factors Affecting ◽

Beijing China

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Residents with mental–physical multimorbidity living in long-term care facilities: prevalence and characteristics. A systematic review

International Psychogeriatrics ◽

10.1017/s1041610212002025 ◽

2012 ◽

Vol 25 (4) ◽

pp. 531-548 ◽

Cited By ~ 18

Author(s):

Anne M. A. van den Brink ◽

Debby L. Gerritsen ◽

Richard C. Oude Voshaar ◽

Raymond T. C. M. Koopmans

Keyword(s):

Problem Behaviors ◽

Long Term Care ◽

Community Dwelling ◽

Mental Illnesses ◽

Prevalence Rates ◽

Care Needs ◽

Term Care ◽

Wide Range ◽

Specific Care

ABSTRACTBackground:Aging societies will be confronted with increased numbers of long-term care (LTC) residents with multimorbidity of physical and mental disorders other than dementia. Knowledge about the prevalence rates, medical and psychosocial characteristics, and care needs of this particular group of residents is mandatory for providing high-quality and evidence-based care. The purpose of this paper was to review the literature regarding these features.Methods:A systematic literature search was conducted in PubMed, EMBASE, PsycINFO, and CINAHL from January 1, 1988 to August 16, 2011. Two reviewers independently assessed eligibility of studies on pre-established inclusion criteria as well as methodological quality using standardized checklists.Results:Seventeen articles were included. Only one small study describes multimorbidity of a wide range of chronic psychiatric and somatic conditions in LTC residents and suggests that physical–mental multimorbidity is rather rule than exception. All other studies show prevalence rates of comorbid physical and mental illnesses (range, 0.5%–64.7%), roughly in line with reported prevalence rates among community-dwelling older people. LTC residents with mental–physical multimorbidity were younger than other LTC residents and had more cognitive impairment, no dementia, and problem behaviors. Care needs of these residents were not described.Conclusions:Although exact figures are lacking, mental–physical multimorbidity is common in LTC residents. Given the specific characteristics of the pertaining residents, more knowledge of their specific care needs is essential. The first step now should be to perform research on symptoms and behavior, which seem more informative than diagnostic labels as well as care needs of LTC residents with mental–physical multimorbidity.

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Range in systolic blood pressure and care-needs certification in long-term care insurance in community-dwelling older patients with chronic kidney disease

Journal of International Medical Research ◽

10.1177/0300060517721795 ◽

2017 ◽

Vol 46 (1) ◽

pp. 293-306 ◽

Cited By ~ 1

Author(s):

Taroh Himeno ◽

Tazuo Okuno ◽

Keisuke Watanabe ◽

Kumie Nakajima ◽

Osamu Iritani ◽

...

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Older Patients ◽

Long Term Care ◽

Community Dwelling ◽

Care Needs ◽

Term Care ◽

Long Term Care Insurance ◽

Older Subjects

Objective Low systolic blood pressure (SBP) is associated with an increased risk for cardiovascular morbidity/mortality in older patients with chronic kidney disease (CKD). The present study evaluated the association between range in blood pressure and first care-needs certification in the Long-term Care Insurance (LTCI) system or death in community-dwelling older subjects with or without CKD. Methods CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m2 or dipstick proteinuria of + or greater. Our study was conducted in 1078 older subjects aged 65–94 years. Associations were estimated using the Cox proportional hazards model. Results During 5 years of follow-up, 135 first certifications and 53 deaths occurred. Among patients with CKD, moderate SBP (130–159 mmHg) was associated with a significantly lower adjusted risk of subsequent total certification (hazard ratio [HR] = 0.44) and subsequent certification owing to dementia (HR = 0.17) compared with SBP < 130 mmHg. These relationships were not observed in non-CKD subjects. Conclusion Lower SBP of <130 mmHg may predict a higher risk for subsequent first care-needs certification in LTCI, especially for dementia, in community-dwelling patients with CKD.

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Use of personal call alarms among community-dwelling older people

Ageing and Society ◽

10.1017/s0144686x12000803 ◽

2012 ◽

Vol 34 (1) ◽

pp. 67-89 ◽

Cited By ~ 14

Author(s):

SAMUEL R. NYMAN ◽

CHRISTINA R. VICTOR

Keyword(s):

Older People ◽

Activities Of Daily Living ◽

Daily Living ◽

Community Dwelling ◽

Living Alone ◽

Cross Sectional ◽

Term Care ◽

Community Dwelling Older People ◽

Serious Injury

ABSTRACTHaving a fall and then lying on the floor for an hour or more is known as a ‘long lie’, which is associated with serious injury and an elevated risk of admission to hospital, long-term care and death. Personal call alarms are designed to prevent long lies, although little is known about their use. Using cross-sectional data from the English Longitudinal Study on Ageing, this study investigated the proportion of self-reported users of personal call alarms among 3,091 community-dwelling adults aged 65+ who reported difficulties of mobility or activities of daily living. The characteristics of users were then explored through logistic regressions comparing those living alone with those living with others. One hundred and eighty people self-reported using a personal call alarm (6%). Multivariate regression found the following to significantly predict personal call alarm use among both those living alone and with others: greater difficulty with activities/instrumental activities of daily living, older age, and for those living with others only: lower score on the quality of life subscale for control. Personal call alarm use may be markedly lower than the 30 per cent annual incidence of falls among community-dwelling older people. Better understanding is needed of the reasons for low usage, even amongst those at highest falls risk for whom such alarms are most likely to be beneficial.

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Is informal care sufficient to meet the long-term care needs of older people with disabilities in China? Evidence from the China Health and Retirement Longitudinal Survey

Ageing and Society ◽

10.1017/s0144686x1900148x ◽

2019 ◽

pp. 1-20 ◽

Cited By ~ 1

Author(s):

Wei Yang ◽

Si Ying Tan

Keyword(s):

Older People ◽

Informal Care ◽

Daily Living ◽

Long Term Care ◽

Unmet Needs ◽

People With Disabilities ◽

Care Provision ◽

Care Needs ◽

Term Care

Abstract Rapid demographic shifts and socio-economic changes are fuelling concerns over the inadequate supply of informal care – the most common source of care-giving for older people in China. Unmet long-term care needs, which are believed to cause numerous adverse effects on health, continue to increase. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this study explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities. We then analyse whether a higher intensity of informal care leads to lower unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e. less than 80 hours per month. Besides, a higher intensity of informal care received could significantly lower the probabilities of unmet needs for the disabled older adults who have mainly instrumental activities of daily living limitations. Our study points out that informal care cannot address the needs of those who are struggling with multi-dimensional difficulties in their daily living. Our findings highlight a pressing need for the government to buttress the formal care provision and delivery systems to support both informal care-givers and disabled older people in China.

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Evaluating the quality of long-term care services in the city of La Plata, Argentina

Ageing and Society ◽

10.1017/s0144686x1900103x ◽

2019 ◽

Vol 41 (1) ◽

pp. 208-230

Author(s):

Peter Lloyd-Sherlock ◽

Bridget Penhale ◽

Nelida Redondo

Keyword(s):

Older People ◽

Long Term Care ◽

State Regulation ◽

Care Needs ◽

Term Care ◽

Middle Income ◽

La Plata ◽

Regulatory Processes ◽

Care Systems

AbstractThis paper reports on an innovative survey of long-term care facilities for older people in the Argentine city of La Plata. It applies a range of qualitative methodologies, including a clandestine audit conducted by older people living in the community. The paper pays particular attention to the types and availability of services, perceived quality and the rigour of regulatory processes. It finds that there has been a rapid growth in the availability of formal services, but that there are many gaps in provision, especially for older people with complex care needs. There are strong indications that service quality is uneven and, in some cases, this amounts to the contravention of basic human rights. State regulation is hampered by institutional fragmentation and weak governance. A wider set of expert interviews and the limited available published information indicate that these findings are unlikely to be exceptional, and that similar issues affect rapidly emerging long-term care systems in many low- and middle-income countries.

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